The New England Comparative Effectiveness Public Advisory Council Holds Public Meeting on Treatment for Atrial Fibrillation
– Finds Evidence Lacking for Minimally Invasive Surgical Ablation and Catheter Ablation Prior to Drug Treatment –
Boston, Mass., July 26, 2011 – A report with the analyses and outcomes of the inaugural public meeting of the New England Comparative Effectiveness Public Advisory Council (CEPAC) has been released by the Institute for Clinical and Economic Review (ICER). ICER is a leading academic comparative effectiveness research group based at the Massachusetts General Hospital’s Institute for Technology Assessment. The meeting was held to consider the evidence on ablation treatment options for patients with atrial fibrillation. The report on the meeting includes the material used by the CEPAC in its deliberations, including supplementary analyses to augment the review of radiofrequency catheter ablation for the treatment of atrial fibrillation produced by the Agency for Healthcare Research and Quality (AHRQ). The report also presents the results of the votes taken by CEPAC on the adequacy of evidence to demonstrate the comparative clinical effectiveness and value of different approaches to ablation. The report concludes with key policy recommendations from the CEPAC to help guide researchers, providers, and payers to generate and apply evidence in ways that will improve the quality and value of ablation services across New England.
“The first public meeting of CEPAC represents a rare opportunity for practicing clinicians and public representatives to participate directly in helping provide guidance on how evidence should be interpreted and applied by payers and other policy makers,” stated Steven D. Pearson, MD, MSc, President of ICER. “The report from CEPAC will also offer the medical research community recommendations and ideas for how to improve the future evidence base for treatments of patients with atrial fibrillation.”
Among the key voting issues covered by the CEPAC were findings on the use of catheter ablation to treat patients without first trying medical management. For this use of catheter ablation the CEPAC voted 16 to 0 that the evidence was inadequate to demonstrate that ablation was as good, or better, than medical management. Similarly, CEPAC voted 16 to 0 that the evidence to support the use of minimally invasive surgical ablation was not sufficient to demonstrate equivalent or superior outcomes. In contrast, CEPAC voted 15 to 1 that the evidence was adequate to demonstrate superior clinical effectiveness for catheter ablation to treat patients who had tried medical management first without adequate response to medical management alone. CEPAC also reviewed the budget impact and cost-effectiveness of ablation technologies and voted that, at current Medicare reimbursement rates, the use of catheter ablation after the failure of medical management represents a “reasonable” value for New England public and private payers.
In its policy recommendations, CEPAC provided suggestions for hospitals, clinicians and payers. Among the most compelling recommendations are calls for collaboration in establishing more opportunities for patients to obtain performance data on individual clinicians and hospitals as part of enhanced shared decision-making; development of clear training standards for clinicians performing catheter and surgical ablation; and the creation of patient registries and other mechanisms for capturing patient outcomes for innovative, new approaches to ablation as they enter clinical practice. The full list of recommendations is available in the final report.
CEPAC is slated to next meet in December 2011 and will be reviewing ICER’s adaptation of AHRQ’s review “Nonpharmacologic Interventions for Treatment-Resistant Depression in Adults.” Over the coming weeks, the CEPAC website – cepac.icer-review.org – will have the latest information about the adaptation process, including instructions for making public comments, and meeting registration.
CEPAC is a regional body whose goal is to provide objective, independent guidance on the application of medical evidence to clinical practice and payer policy decisions across New England. Supported by a federal grant from the Agency for Healthcare Research and Quality (AHRQ), and with backing from a consortium of New England state health policy leaders, CEPAC holds public meetings to consider evidence reviews of medical tests and treatments and provide judgments regarding how the evidence can best be used across New England to improve the quality and value of health care services. CEPAC consists of practicing physicians with experience in evaluating and using evidence in the practice of healthcare, as well as patient/public members with experience in health policy, patient advocacy and public health. ICER is managing the day-to-day operations of CEPAC as part of its federally funded RAPiD (Regional Adaptation for Payer Policy Decisions) initiative meant to develop and test new ways to adapt federal evidence reviews to improve their usefulness for patients, clinicians, and payers. A list of CEPAC members, and other information about the project, is available online at cepac.icer-review.org.
The Institute for Clinical and Economic Review (ICER), based at the Massachusetts General Hospital’s Institute for Technology Assessment (ITA) and an affiliate of Harvard Medical School, provides independent evaluation of the clinical effectiveness and comparative value of new and emerging technologies. Structured as a fully transparent organization, ICER seeks to achieve its ultimate mission of informing public policy and spurring innovation in the use of evidence to improve the value of health care for all. For more information, please visit www.icer-review.org.